Transcript Chapter 22 Urinary Elimination

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Established incontinence: involuntary loss of urine
that can have abrupt or sudden onset and is
chronic
Functional incontinence: loss of voluntary control
of urine due to disabilities that prevent
independent toileting, sedation, inaccessible
bathroom, medications that impair cognition, or
any other factor interfering with the ability to reach
a bathroom
Neurogenic (reflex) incontinence: loss of control of
voiding due to inability to sense the urge to void
or control urine flow
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Nocturia: voiding at least once during the
night
Overflow incontinence: involuntary loss of
urine due to an excessive accumulation of
urine in the bladder
Stress incontinence: involuntary loss of
urine when pressure is placed on pelvic
floor (laughing, sneezing, or coughing)
Transient incontinence: involuntary loss of
urine that is acute in onset and usually
reversible
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Urinary problems are often not easily
discussed by or with the older adult
May result in delayed detection, diagnosis,
and treatment
Negatively impacts total body health and
psychosocial well-being
Nurses can develop patient relationships that
help older adults to comfortably discuss
urinary tract issues
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Hypertrophy and thickening of the bladder
muscle
◦ Decreases bladder ability to expand
◦ Reduces storage capacity
 Daytime urinary frequency
 Nocturia
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Changes in cortical control of micturition
◦ Nocturia
Inefficient neurological control of bladder
emptying and weaker bladder muscle
◦ Retention of large volumes of urine-most
common cause:
 Female: fecal impaction
 Male: prostatic hypertrophy
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Kidney filtration ability decreases
◦ Affects the ability to eliminate drugs
 Potential for adverse drug reactions
Reduced renal function
◦ High blood urea nitrogen levels
 Causing lethargy, confusion, headache,
drowsiness
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Decreased tubular function
◦ Concentration of urine changes in response to water
and/or sodium excess/depletion
 Maximum specific gravity changes
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Increase in renal threshold for glucose
◦ False-negative results for glucose in the urine
without symptoms
Is the following statement True or False?
Urinary frequency is caused by the normal agerelated changes of hypertrophy of the bladder
muscle and thickening of the bladder.
True
One of the elimination problems that face older adults
is urinary frequency, caused by hypertrophy of the
bladder muscle and thickening of the bladder. These
changes decrease the bladder’s ability to expand and
thus reducing storage capacity.
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Adequate fluid intake
Maintenance of acidic urine
Avoidance of catheterization
Appropriate level of activity
Frequent toileting
Interventions and education to enhance voiding
and prevent retention
Nursing assessment
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Common embarrassing and bothersome
symptom/issue for older adults
Incidence/prevalence
Not normal aging
Age-related changes increase the risk
Can be transient or established
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Stress: weak pelvic muscles
Urgency: UTI, enlarged prostate, pelvic or
bladder tumors
Overflow: bladder neck obstructions, meds
Neurogenic (reflex): cerebral cortex lesions,
MS, neural pathway disturbances
Functional :dementia, sedation, inaccessible
bathroom, meds that impair cognition
Mixed: combination of factors
Which of the following types of incontinence is
caused by bladder neck obstructions and
medications?
a. Stress incontinence
b. Urgency incontinence
c. Overflow incontinence
d. Neurogenic (reflex) incontinence
c.
Overflow incontinence
Overflow incontinence is associated with bladder
neck obstructions and certain medications
(adrenergics, anticholinergics, and calcium
channel blockers). Bladder muscles fail to contract
or periurethral muscles do not relax, leading to
excessive accumulation of urine in the bladder.
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Important to question older adult about UI during
every routine assessment
Medical history
Medications
Functional status
Cognition
Neuromuscular function in lower extremities
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Urinary control and retention
Bladder fullness and pain
Elimination pattern
Presence of fecal impaction
Symptoms
Diet (type of food/fluid intake and amount)
Reactions to urinary incontinence
Referral for comprehensive medical evaluation
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Initial goal is to identify the cause
Treatment goals are developed based on the
underlying cause and type of UI
Comprehensive evaluation
Interventions implemented
Positive reinforcement and encouragement
are extremely beneficial
Is the following statement True or False?
Half of all patients who have received an
indwelling Foley catheter will develop
bacteriuria within the first 24 hours after being
catheterized.
True
Indwelling catheters should be used only in
special circumstances and never for the
convenience of staff. Half of all patients will
develop bacteriuria within the first 24 hours of
being catheterized and 35% to 40% of all
nosocomial infections are catheter-associated
urinary tract infections.
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Incidence: increases with age; men 3x rate of
women, 90% are over 55 years
Risk factors: chronic irritation, exposure to dyes,
cigarette smoking
Signs and symptoms: similar to bladder infection
(frequency, urgency), painless hematuria is the
primary sign
Diagnosis: cystoscopic exam
Treatment: surgery, radiation, chemo-depends on
the extent and location of the lesion
Observation for signs of metastasis: back pain or
pelvic pain
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Causes of stone formation: immobilization,
infection changes in pH or concentration of
urine, dehydration, hypercalcemia
Signs and symptoms: pain, hematuria, UTI
symptoms, GI upset
Diagnosis: FLANK PAIN, CT scan, IVP
Treatment: analgesia, shock wave lithotripsy,
ureteroscopy, lap or open lithotomy
Nursing interventions: prevention of urinary
stasis, ample fluids, facilitate prompt
treatment of UTI’s
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Acute and chronic: chronic already exists in older
adults who develop an acute condition
Signs and symptoms: may be subtle and
nonspecific: fever, fatigue, nausea, vomiting,
anorexia, elevated BP, increased sed rate (page
312-others)
Diagnosis: blood tests for creatinine & eGFR, and
ANA; urine dip for blood & protein
Treatment: antibiotics, restricted sodium and
protein diet
Nursing interventions: monitor fluid I & O, close
observation for toxic medication effects (esp.
digitalis, diuretics, antihypertensives)
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Need for sensitivity while discussing urinary
problems with the older adult
Consider fear and anxiety toward urinary
incontinence
Provide education and realistic expectations
Involve all members of the health care team
Use discretion
Maintain dignity